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Defense Sexual Assault Incident Unrestricted Reporting
Defense Sexual Assault Incident Reporting
OMB: 0704-0482
IC ID: 200363
OMB.report
DOD/DODDEP
OMB 0704-0482
ICR 202105-0704-001
IC 200363
( )
Documents and Forms
Document Name
Document Type
Form DD Form 2965
Defense Sexual Assault Incident Unrestricted Reporting
Form
DD Form 2965 Defense Sexual Assault Incident Database (DSAID) Data Fo
DD2965 draft 20211014.pdf
Form
DD Form 2910 Victim Reporting Preference Statement
DD2910 draft 20220110.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Defense Sexual Assault Incident Unrestricted Reporting
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
DD Form 2965
Defense Sexual Assault Incident Database (DSAID) Data Form
DD2965 draft 20211014.pdf
Yes
Yes
Fillable Fileable
Form
DD Form 2910
Victim Reporting Preference Statement
DD2910 draft 20220110.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Defense and National Security
Subfunction:
Operational Defense
Privacy Act System of Records
Title:
DHRA 06 Defense Sexual Assault Incident Database
FR Citation:
79 FR 38534
Number of Respondents:
5,640
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
25 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
5,640
0
4,942
0
0
698
Annual IC Time Burden (Hours)
14,100
0
12,355
0
0
1,745
Annual IC Cost Burden (Dollars)
370,999
0
325,085
0
0
45,914
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.